title: Transapical closure of mitral paravalvular leaks with use of amplatzer vascular plug III.
abstract: BACKGROUND
  Paravalvular leak (PVL) may complicate cardiac valve replacement surgery. Radical treatment is required if a PVL produces heart failure (HF) symptoms or severe hemolysis. Even though transcatheter PVL closure (TPVLC) has become a valid alternative to reoperation, a number of anatomical conditions may prove technically challenging for transvascular access. We intended to verify the utility of transapical access in such settings.
  
  
  METHODS
  We report a prospective series of 7 patients with mitral PVLs who underwent transapical TPVLC. The Heart Team made the choice of treatment and Amplatzer Vascular Plug III devices were used off-label as occluders.
  
  
  RESULTS
  Transapical TPVLC enabled excellent sealing of mitral PVL in 6 cases. This resulted in HF symptom reduction and decreased NT-proBNP plasma concentration. No procedure-related complications occurred.
  
  
  CONCLUSIONS
  Transapical access seems to be an efficient and safe alternative for transvascular approach for mitral TPVLC, but further technical development is still needed.
authors.affiliation: 3rd Division of Cardiology, Medical University of Silesia, Ul.Ziolowa 45/47, 40-635 Katowice, Poland. grsm18@wp.pl.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Smolka
authors.forename: Piotr
authors.initials: P
authors.lastname: Pysz
authors.forename: Marek
authors.initials: M
authors.lastname: Jasinski
authors.forename: Radosław
authors.initials: R
authors.lastname: Gocoł
authors.forename: Wojciech
authors.initials: W
authors.lastname: Domaradzki
authors.forename: Damian
authors.initials: D
authors.lastname: Hudziak
authors.forename: Marek
authors.initials: M
authors.lastname: Deja
authors.forename: Andrzej
authors.initials: A
authors.lastname: Ochała
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Gasior
mesh_terms: D000818:Animals; D006328:Cardiac Catheterization / Q000379:methods*; D004195:Disease Models, Animal; D004452:Echocardiography; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D055989:Septal Occluder Device; D013552:Swine